The following study is from “Reforming VA’s Medication Copayment Statute” by Timothy J. McDonald. “..graduate of the Health Law Certificate Program at the University of Pittsburgh School of Law and is currently serving as a Presidential Management fellow in the Patient Care Services Office of the Veterans Health Administration.” A link follows. This is followed by studies showing the effect of the VA copay increases.

“The limitation imposed by the copayment legislation that prevents VA from charging the veteran more than the cost of the medication to VA has led to at least one case before the Board of Veterans’Appeals (Board). 31 This case involved “pill splitting,” a practice where VA provides medication in a dosage that is higher than needed, and then has the patient split a single pill into two separate doses”

“However, the current medication copayment that many veterans are charged is based on outdated legislation…”

“This problem is not limited to cases where the veteran is splitting tablets. In fact, based on VA’s increased efficiency and price negotiation in the pharmaceutical arena, it seems very likely that under the current copayment plan many veterans are charged excessive copayments by VA.44”http://www.va.gov/vbs/bva/manuals/vlr1mcdonald.pdf

]]>By: William H. Heino Sr.http://dissidentvoice.org/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-21520
Sun, 01 Jun 2008 16:52:47 +0000http://www.dissidentvoice.org/new/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-21520For the reasons made obvious as you read, the Board of Veterans’ Appeals, so-called veterans’ court, once again, are determined in frustrating my efforts in appealing my claim, by a still further delay. Is there something about this case that warrants this delay?
Could the reason be, of the well over 1.1 million VA prescriptions, veterans are being over-charged?
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My claim, VA violation of 38 USC 1722A was denied by the Board of Veterans Appeals. I then filed with the United States Court of Appeals for Veterans Claims (CVA). On 7/11/2007 was remanded back to the Veterans Board of Appeals (BVA). The BVA lost and rebuilt the file, that being the reason for the remand. After repeated checking, as of 5/20/08, now 10 months later, this remand, has not been returned to the BVA. So they say. It is obvious they may have lost it again in order that this claim, or I, would go away. Disappear. Perhaps I’ll die? Case closed!
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VA prescriptions are dispensed in supplies of 90 days. However, for those unfamiliar with my claim, to explain these over-charges by the VA in violation of 38 USC 1722A, this example will be at it’s simplest and most understandable throughout my explanation, . Let’s say that you are at the VA, standing in line getting your prescription. The vet in front of you is getting the exact same prescription. She picks up her 30 day supply of 30 pills. Her copay for a 30 day supply of 30 pills is $8. You also are dispensed an $8 supply of 30 pills of the same exact prescription. Being that your condition is not as severe, your prescription requires you to split this 30 pill $8 supply. After you sit down at your kitchen table and split your 30 pill supply, now you have 60 split pills, a 2 month supply. But hold on! Except your co-payment cost for this 30 pill, $8 supply, now that it has been split, has increased. It now carries a co-payment of $16. This explains how veterans’ has been overcharged by the VA since 2002. Shafted again (3/13/07) by the Board of Veterans Appeals in their phony denial. Do you see anything wrong? You should!
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“Pursuant to Section 20.1404(b) (2002), the motion alleging clear and unmistakable error in a prior Board decision must set forth clearly and specifically the alleged clear and unmistakable error, or errors, of fact or law in the Board decision, the legal or factual basis for such allegations, and why the result would have been different but for the alleged error.”
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The two persons listed on the denial that had crafted, and fashioned up the logic that follows? Board of Veterans’ Appeals counsel M. Taylor, and Veterans’ Law Judge, Judge John E. Ormand. I will show you exactly where, in their efforts to mislead, and to rewrite the law. This is the kind of garbage veterans have to put up with! Let’s look at the reasoning in their BVA denial.
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Cited on the cover page of my denial was, “THE ISSUE. Whether the veteran is obligated to pay the Department of Veterans Affairs (VA) a copayment for each 30-day or less supply of medication provided by the VA on an outpatient basis in an amount established under 39 C.F.R. § 17.110.”
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“Criteria & Analysis by the Board of Veterans Appeals.” 3/13/ 2007
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Here the Board understands the problem. “The record reflects that the appellant is prescribed a 12.5 mg daily dose of his medication. Because the medication is not dispensed in a 12.5 mg tablet, his physician has instructed him to split a 25 mg tablet in half to achieve the proper daily dosage. Thus, he receives a 30-day prescription consisting of fifteen 25 mg pills, each of which he splits in half to take one half of a pill per day. The appellant contends that the standard co-payment is excessive in light of the pill splitting.” However, no where in my claim did I mention the word ‘standard’, nor was the word ‘standard’ mentioned in 38 USC 1722A, or Federal Register, Final Rule. Here, in introducing ‘standard’, supposedly for the purpose of establishing two (2) ‘standard’ co-payments, counsel Taylor purposely has rewritten the law, in order to mislead.
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“In addition, the Board notes that the reference to the cost of medication contained in 38 U.S.C.A. Sec. 1722A clearly pertains to VA’s cost in dispensing the medication, not the cost to the appellant.” Is there a difference? My claim…clearly pertains to VA’s co-pay cost in dispensing medication, and it’s inflated cost to the appellant! Which is the “excess of the cost” for the ‘standard’ co-payment, and is then arbitrarily increased, to those veterans required to split their 30-pill, $8 supplies. Dispensed exactly the same, and in like manner, as all other VA dispensed ‘standard’ co-payment and abundant 30-day $8 supplies of 30-45-60-90 pills.
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Counsel Taylor references remarks from the July 16, 2001 Federal Register. “Also, as we stated in the proposal, under 38 U.S.C. 1722A, VA may not require a veteran to pay an amount in excess of the actual cost of the medication and the pharmacy administrative costs related to the dispensing of the medication. VHA conducted a study…and found that the VA incurred a cost of $7.28 to dispense an outpatient medication even without consideration of the actual cost of medication..”
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Dispensing! Where there is no difference in the prescription, supply amount, handling, or dispensing time, a 30 pill supply is dispensed, with a $16 co-payment. Interestingly, in the same exact manner as all 30-day, 30 pill $8 supplies are dispensed, as explained in the Federal Register! No splitting of pills was involved in the dispensing procedure. However, of an exact same $8 dispensed supply, automatically these ‘standard’ 30-day $8 co-payment whole pill supplies are increased 100% (2 month split pill supply).
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Counsel Taylor, citing, “1722A clearly pertains to VA’s cost in dispensing”. Counsel Taylor just does not get it! Nor does Judge Ormand. Their is no difference! No difference in dispensing two supplies that are exactly alike in prescription and supply, or to the cost related to dispensing! However, counsel Taylor is emphatic in making the point, conclusive, that it clearly pertains to the cost in dispensing? Or is it the ISSUE, the ” 30-day or less supply”? For some unknown reason, which counsel Taylor did not elaborate on, a second exact duplicate supply increases, double the co-pay cost? Although, counsel Taylor may have tried, but failed.
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“38 USC 1722A; (a)(1) Subject to paragraph (2), the Secretary shall require a veteran to pay the United States $8 for each 30-day supply of medication furnished such veteran under this chapter on an outpatient basis for the treatment of a non-service-connected disability or condition. If the amount supplied is less than a 30-day supply, the amount of the charge may not be reduced.” Which then also means, if the amount is not less than 30-day supplies, as described in paragraph (1) the Secretary may not require a veteran to pay an amount in excess of the cost for medication provided to a veteran as described in paragraph (2).
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Citing my argument, BVA’s counsel Taylor, quotes inaccurately, to confuse, again to mislead. 38 USC 1722A “Copayment for medications. Paragraph (2) The Secretary may not require a veteran to pay an amount in excess of the cost of the Secretary for medication as described in paragraph (1).”
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The correct reading is, “(2) The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication described in paragraph (1).”
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“The appellant has not cited to, and the Board is unable to find any authority allowing for a deviation from the standard copayment.” The Board is right! I too, am unable to find that authority.
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Where the Board got it wrong! Of all what you have understood and read so far, what follows puts to rest any doubts as to the 30-day medication over-charges in my claim, and refutes the reasoning of the Board of Veterans’ Appeals in their reading of 38 USC 1722A. Of everything that has been explained, BVA counsel Taylor’s reference to 38 USC 17.110, (addressed in my claim) is the key to explaining, what counsel Taylor and Veterans Law Judge John E. Ormand, and the VA failed to, or did not, want to comprehend, or consider in their thinking, in understanding 38 USC 1722A.
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The Board counsel Taylor, referenced 38 USC 17.110; Copayments for Medication. “..a veteran is obligated to pay a copayment for each 30-day or less supply of medication provided by the VA on an outpatient basis (other than medication administered during treatment).”
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Counsel Taylor made it a point to reference 17.110. Veterans’ do know we have to pay a co-payment. THE ISSUE was obviously a “30-day or less supply.” The Board’s main argument to my claim, is their erroneous interpretation of what the law is. “Each 30-day or less supply”, is suggesting to them, an across the board 30-day 15 pill supply is less. However, “..each 30-day or less supply”, refers to only one (1) condition. Veterans who may visit a VA facility on a one time basis as an outpatient. For emergency room care, or see a doctor for a cut finger, brief illness, etc. I wish counsel Taylor would explain another circumstance in which a veteran may be charged an “excess of the cost”? Please enlighten us. I know of no other “excess of the cost” than what I claim.
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Counsel Taylor better not again, bring up 15 pills is less than a 30-day supply! The reality is, a veteran who falls under the 17.110 meaning, “obligated to pay a co-payment for each 30-day or less supply…on an outpatient basis (other than medication administered during treatment.)”, refers to medication, in a dispensed 30-day supply of 15 pills, for treatment on an outpatient basis. The veteran in fact is not receiving less than a 30-day supply, this is his full 30-day monthly supply during outpatient treatment! For this reason, as described in 1722A, paragraph (2) is the basis for my claim. A 30-day, 30-pill, dispensed supply, for treatment, whether or not it is split, according to 1722A carries the maximum co-payment of $8. Which the Board refuses to recognize, but rather relies on a “each 30-day or less” argument. “The secretary may not require a veteran to pay an amount in excess of the cost, for medication described in paragraph (1).” $8 for each dispensed 30-pill, 30-day supply co-payment, includes supplies of the abundant 30-day supplies of 45-60 or 90 pills, and as well for all veterans’ under treatment, receiving a same exact dispensed 30-pill supply. A prescribed 2 month supply (split pill).
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Counsel Taylor in an effort in re-enforcing the Board’s position cites “(b) The Secretary, pursuant to regulations which the Secretary shall prescribe may-…(1) increase the co-payment amount in effect under subsection (a);..” Pursuant to regulations? Means according to the law! To regulations as written. Where is this regulation mentioned in the Code of Federal Regulations, this “standard” co-payment you talk about, for $16 split pill supplies? Where, counsel Taylor, does it mention increased co-payment cost for one of two (2) exact duplicate 30-day prescription supplies? Other than my example, where is it mentioned 15 pills is less than 30-day supply? “The Administrative Procedure Act requires that agencies publish administrative regulations in the Federal register before they can be legally effective.” Where?
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The VA, and the BVA , they want me to pass on, disappear. When that happens, veterans you lose. They don’t want you to win. However, this claim will live on, when other veterans think it’s important enough of a veteran’s issue to file a claim. Turned down by the RO, it’s (BVA) $50 filing fee is well spent. A younger veteran, whose prescription requires splitting, can file right now, and can keep playing the same silly game that the VA and the BVA insists on playing, just as long as they can.
]]>By: William H. Heino Sr.http://dissidentvoice.org/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-19687
Fri, 02 May 2008 14:31:26 +0000http://www.dissidentvoice.org/new/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-196875/2/08 UPDATE VA violation of 38 USC 1722a

Here is an updated example of how veterans’ are treated by our government, and how a veterans’ due process, is again being denied. I have been working on this since March of 2002. After my withholding of medication co-payment over-charges, the VA turned over this alleged indebtedness to the Department of the Treasury. This action was taken without explanation, the denied due process.
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In April 2005 I filed a claim against the Veterans Administration in violation of 1722a, VA prescription over-charges with the Board of Veterans’ Appeals. They denied my claim, and at some point, they conveniently lost the original.
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I then went to the United States Court of Appeals for Veterans’ Claims. My claim was remanded back to the BVA. I was notified of this remand on July 16, 2007. The reason for the remand, the USCAVC would work with a rebuilt claim.
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Seven (7) months later, on Feb. 11, 2008, I called the BVA inquiring about my claim. I was told it was “coming back from the Court, but hasn’t reached us yet.” On 4/10/2008, I called again asking for it’s status. “Still at the Court of Veterans Appeals.” For this advisement, 4/30/2008 I called the Board of Veteran Affairs again. My claim has still not been returned to the court. It’s been now over nine (9) months! Because it has not been returned, the courts either, have lost my claim a second time, or are intentionally delaying, stalling, and awaiting my death.
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Are they not in the same town? Is my claim such a hot item that the VA does not want to adjudicate it? Apparently so. I know they want me to die! Then my claim dies. This is how the VA works. How our courts work. And how veterans’ are continually being treated. There is no due process. Think this is bad? You haven’t seen nothing yet. Wait till our men and women return from Iraq and Afghanistan.

The Board of Veterans’ Appeals, denial, Conclusion of Law, states, “The appellant is obligated to pay VA copayment for each 30-day or less supply of medication provided by VA on an outpatient basis. 38 U.S.C.A. Sec. 1722a; 38 C.F.R. Sec. 17.110 (2006).”

Finally, after the Criteria and Analysis, and references to other law statutes, the Board, in concluding states, “38 USCA 1722a clearly pertains to VA’s cost in dispensing the medication, not the cost to the appellant… The Federal register of July 16th, 2001; Also under U.S.C. 1722A, VA may not require a veteran to pay an amount in excess of the actual cost of medication and pharmacy administrative costs related to the dispensing of the medication. VHA conducted a study…and found that the VA incurred a cost of $7.28 to dispense an outpatient medication….under these circumstances, we believe that a $7 copayment would not exceed VA’s cost.”

Clearly, dispensing of medication is the key to the Board’s argument, as well as mine.

The VA pharmacy dispenses a supply of 30 pills, the copay cost, whether the amount is 15, 30, 60, or 90 pills the copay is $8. A 30 pill prescription may require that the supply be split. Now becoming a 2 month supply. VA’s copayment charge is $16.

A supply of 30 pills carries the maximum copayment charge of $8, for a 30-day supply, and a veteran is not required to pay an amount in excess of the cost to the Secretary, as described in 38 USC 1722a paragraph 2, and noted in the Decision of the Board of Veterans Appeals reference. The Board citing the Federal register, 12/6/2001. “The VA incurred a cost of $7.28 to dispense an outpatient medication..” (rounded out to $8). Why is it, that a veteran is charged $16 for the exact same $8 prescription, 30 pill supply?

The BVA in denying the appeal, they cite, “.. 1722a clearly pertains to VA‘s cost in dispensing the medication…,The VA incurred a cost…to dispense medication..”, providing the answer to their apperception. Dispensing! The VA charges the veteran twice, or double, as claimed, for the same dispensing cost required to dispense the exact same, one(1) 30-day, $8 supply. Exceeding the cost a veteran is not required to pay. I, like the Board, I am, “..unable to find any authority allowing for a deviation from the standard copayment.” As well, “The Board has no authority to act outside the constraints of the statutory and regulatory criteria.”

Re: William H. Heino v. R. James Nicholson, Secretary of Veterans Affairs..
In the United States Court of Appeals for Veterans Claims. 7/11/2007. “James Nicholson Secretary of veterans Affairs respectfully moves the Court to vacate and remand the march 13, 2007 decision of the Board of veterans Appeals…”

“The file was not received or logged at the Hines VA Medical facility and moreover, was not returned to the VA Madison medical facility. Upon discovering the file was lost, the file was re-built by the VA medical facility…Appellant’s file was lost and has been re-built, as such, the evidence necessary for effective judicial review…is now only available in the re-built file…the original file relied upon by the Board [CAVC] in rendering the decision on appeal is no longer available for the parties and the court,….the Secretary cannot use the re-built file because the Board [BVA] did not rely on that file in rendering it’s March 13, 1007, decision.”

“Therefore, the Secretary respectfully moves the Court to vacate and remand the March 13, 2007, decision, in order to allow the Board [BVA] to re-adjudicate Appellant’s case with the re-built file.”

Now, the good news part of all this, as advised by legal counsel handling veterans‘ claims, “I have to admit, this is unique, in a good sense for you.,, The VA has asked the Court to remand your appeal to the BVA to make a new decision regarding the co-payments. This, in effect, is a win, although …The only remedy the court issues, with only a rare exception, is a remand. Reversals (an outright win for the appellant) can be counted on one hand on an annual basis. So this is what we believe would happen anyway, only it would be a year or so down the line.”

So, I say to all that have been following this 1722a issue, is, let’s go with the good news feeling that I got out of this. Although, while we wait this out, illegal co-payment over-charges will continue for thousands, upon thousands, of veterans. I will keep you advised.

]]>By: William H. Heino Sr.http://dissidentvoice.org/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-117
Sat, 05 May 2007 14:33:17 +0000http://www.dissidentvoice.org/new/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-117Hoping it would go unnoticed, the VA is still not embarrassed when it comes to scamming veterans in overcharges in the millions of dollars. Well, it was noticed!

Let’s assume that you, being a veteran, are at the VA picking up your prescription. You and another veteran in line in front of you are prescribed the exact same identical prescription of 30 pills. Both supplies carry a copay of $8. Right? But, your prescription requires that you split your supply. You now have a two month supply (15 pills 1/2 pill per day). This $8 supply now increases in copay cost to $16, for the exact pill medication and supply that costs $8. But let’s kick it up a notch, assume that veteran in front of you, having still the same prescription, his supply for a 30-day supply is instead 90 pills. Copay remains at $8 for this 30-day 90 pill supply.
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Hope this explains, how the veteran is overcharged by the VA, and just got shafted again (3/13/07) by the Board of Veterans Appeals (BVA).What veterans have known as fact, is that veterans continue to lose benefits. This is just another example.
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Criteria & Analysis by the Board of Veterans Appeals.
“. …The appellant contends that the standard copayment is excessive in light of the pill splitting.” No where in my claim did I mention the word ‘standard.’ To determine what then is the standard $8, 30 day supply, one must compare 2 supplies. The VA apparently has two(2) standard supplies. A 30 day supply of 30-60-90 pills. Copayment cost $8. Then a second standard 30 day supply of 15 pills, $8 copay. Two distinct and different standards. A standard in cost, but no standard in supply. One does not have to read any further to see the unfairness of the BVA decision.
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The BVA cites my argument, 38 U.S.C.A. Sec. 1722a “Copayment for medications. Paragraph (2) The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication as described in paragraph (1).” As just described above.
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Paragraph “(a)(1) Subject to paragraph (2), The Secretary shall require a veteran to pay the United States $8 for each 30-day supply of medication furnished such veteran under this chapter on an outpatient treatment of a non-service connected disability or condition. If the amount supplied is less than a 30-day supply, the amount of the charge may not be reduced.” If the ‘standard’, mentioned first by the BVA describing, “The appellant contends that the standard copayment is excessive..” and according to paragraph 1, is $8 for 30-day supplies of 30,60, or 90 pills, why are veterans charged $16 for a 2 month supply of 30 pills?
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“In addition, the Board notes that the references to the cost of medication contained in 38 USC 1722a clearly pertains to VA’s cost in dispensing the medication, not the cost to the appellant.” That statement is incorrect. Copayment For Medication, 1722a, (listed above) clearly, makes no mention the VA’s cost of dispensing medication. It mentions only the veterans’ copayment obligation. A reference is made to the VA cost in the Federal Register, however, the “cost in dispensing the medication” is not the argument. It is the cost in overcharges to the veteran.
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To you, and me it is quite simple. “The Secretary may not require a veteran to pay amount in excess of the cost to the Secretary for medication as described in paragraph (1).” If one supply can be a standard 60, or 90 pill 30 day supply with a copay of $8, how then can a 30 day supply, limited to only 15 pills, for medication administered during treatment lasting several months, at a copay of $8, each 30 day period be standard supply? “…As described in paragraph (1)”. Therefore, an “excess of the cost” does indeed exist.
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If given to an eight grade grammar school class this arithmetic problem of the two supplies to find the excess of the cost, what would be their answer? They too, would find that an excess of the cost does exist, “..for medication as described in paragraph (1)” This is a bad sign. Indicating exactly how veterans with disabilities claims, going before the BVA, and Veterans’ Law Judge, John E. Ormand, Jr., are adjudicated.
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“(b) The Secretary, pursuant to regulations which the Secretary shall prescribe may-…(1) increase the copayment amount in effect under subsection (a);..” “Pursuant to regulations” means according to the law as written. The BVA , has decided the Secretary (VA) can make law to fit, rather than prescribe the law, or regulations as written.
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Citing..Under 38 C.F.R. Sec. 17.110 Copayments for medications.
“(b) Copayments. (1) Unless exempted under paragraph (c) of this section, a veteran is obligated to pay VA a copayment for each 30-day or less supply of medication provided by the VA on an outpatient basis (other than medication administered during treatment).” If ‘administered during treatment’ meant hospitalization, that’s not what it says, or should have been worded. But it did not. It is not ambiguous in the context in which it is presented. Citing, ‘on an outpatient basis, other than medication administered during treatment’ The meaning is quite clear. A patient receiving 60, or 90 day outpatient supply is clearly a treatment of a condition, such as a heart condition, diabetes, etc.
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BVA mentions, “Thus, it is clear that the VA’s cost of filling the appellant’s 30-day prescription exceeds the $8 copayment under 38 C.F.R. Sec. 17.110.” Again the argument clearly is not the VA cost as noted in the Federal Register 12/6/2001. When determining the medication copay cost, VA factored in everything, except the cost of the medication. The BVA’s inadequacy, and mindset shown here, is for all to see.
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BVA denial in part, “…adherence in the face of overwhelming evidence in support of the result in a particular case: such adherence would result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the claimant.” Never mind the burden of overcharges, or the benefit flowing to well over 1.1 million veterans whose prescriptions call for pill splitting.
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It is clear, the BVA came up with this denial of overcharges claim due to national budget concerns due to the involvement in Iraq, Afghanistan, and who knows were else. Veterans did not cause that. But men and women went to military service because of it. This is how they get rewarded by a grateful nation. There are many things in life we do not like, but ignoring a veterans’ cause, or the law is not an option. Who lost? Having sat in the lobby of my VA hospital and observed those that passed by, it’s not hard to see, there are many who could use any help they can get, as well those returning from Iraq, Afghanistan, and Walter Reed.
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The filing process for an appeal with the United States Court of Appeals for Veterans Claims has begun.
CVA Docket No.07-0864

]]>By: Menancehttp://dissidentvoice.org/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-13
Sat, 28 Apr 2007 16:34:15 +0000http://www.dissidentvoice.org/new/2007/04/%e2%80%9cdumb-stupid-animals-to-be-used%e2%80%9d-the-us-war-against-its-troops/#comment-13It’s amazing – everything that happened to the Gulf War vets is now happening to the Iraq and Afghanistan vets. And the worst is yet to come: don’t believe the system has changed just because the government was embarassed into doing something about the conditions and care at Walter Reed and elsewhere. It was a forced march.
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